A Multicomponent Schoolyard Intervention Targeting Children's Recess Physical Activity and Sedentary Behavior: Effects After 1 Year

The role of playgrounds in promoting children's health - a scoping review

BACKGROUND

Active outdoor play is important for children's health and development, and playgrounds provide good places for play. However, the importance of playground use for health and well-being is unclear. Our scoping review aims to create an overview of all research on playground use and health benefits for children.

METHODS

Scopus, Web of Science, SportDiscus, and PsycInfo were searched using two search blocks, focusing on 'playground' and 'children' respectively, for publications from 2000 to November 2023. The primary inclusion criterion was examining the relationship between playground use and positive physical, mental, or social health outcomes. Only papers published in English were reviewed. For each publication, we synthesized and condensed the results, categorizing them by playground setting, reported health outcome, participant age group, study design, methodologies, publication's country, year, and 'stage of evidence'.

RESULTS

Data from 247 studies were extracted and nearly 80% of these publications were descriptive or exploratory studies. Fifty-two were intervention studies. Adding playground markings to schoolyards led to increased physical activity. Greening schoolyards had mainly positive effects on social and mental health. In Early Childhood Education and Care, renewing play structures had a positive effect on physical activity in three publications. All Public Open Space interventions we found were different, with mixed effects on health outcomes.

CONCLUSIONS

The existing evidence provides good arguments for policy makers, city planners and school-leaders to invest in adding playground markings in schoolyards as this will likely result in more physical activity. The evidence for the health benefits of investing in new play structures indicated that tailoring the playground to local needs is important as 'one size does not fit all' and playgrounds need to be designed as engaging and interesting places for children's play if they are to generate health benefits. Investing in 'greening' playgrounds is likely to result in social and mental health benefits for children, but does not always result in more physical activity. The research field needs more efficacy and effectiveness studies, and in particular replication and scale-up studies to demonstrate which type of playground interventions are successful.

PROTOCOL

The review protocol was registered at Open Science Framework ( https://doi.org/10.17605/OSF.IO/UYN2V ).

Physical activity interventions in European primary schools: a scoping review to create a framework for the design of tailored interventions in European countries

Introduction

Schools provide a unique environment to facilitate physical activity for children. However, many school-based physical activity interventions have not been effective. We propose a new approach, which allows schools to tailor interventions to their specific context. This scoping review aimed to identify intervention components from previous school-based physical activity interventions to form the basis of a tailored approach in a European setting.

Methods

Joanna Briggs Institute guidelines for conducting scoping reviews were followed. European school-based intervention studies aimed at increasing physical activity in children aged 7-11 years published in English since 2015 were included. Databases searched were Ovid Medline, Embase, PsycINFO, Web of Science Social Sciences Citation Index, ERIC and British Education Index. Data was extracted on intervention components, context-related factors (geographical location, school size, child socioeconomic status and ethnicity), feasibility, acceptability and cost-effectiveness. A data-driven framework was developed to summarize the identified intervention components.

Results

79 articles were included, constituting 45 intervention studies. We identified 177 intervention components, which were synthesized into a framework of 60 intervention component types across 11 activity opportunities: six within the school day, three within the extended school day and two within the wider school environment. Interventions most frequently targeted physical education (21%), active and outdoor learning (16%), active breaks (15%), and school-level environmewnt (12%). Of the intervention components, 41% were delivered by school staff, 31% by the research team, and 24% by external organizations. Only 19% of intervention studies reported geographical location and only 10% reported school size. Participant ethnicity and socioeconomic information was reported by 15% and 25%, respectively. Intervention acceptability was reported in 51% of studies, feasibility in 49%, and cost effectiveness in 2%.

Discussion

This review offers a first step in developing a future framework to help schools to develop context-specific, tailored interventions. However, there was a lack of reporting of contextual factors within the included studies, making it difficult to understand the role of context. Future research should seek to measure and report contextual factors, and to better understand the important aspects of context within school-based physical activity.

Objectively assessed school-based intervention to reduce children's sedentary time: a systematic review

Childhood is a period characterized by a constant increase in sedentary time (ST) but also provides a great window of opportunity for children to learn how to limit ST. As a result, school-based interventions aimed at reducing and preventing children's ST are increasingly becoming more widespread. A previous review found that school-based multi-component interventions appeared to be more effective in comparison to those based on a single component. However, this conclusion was based on just 11 studies published before 2016 and needs to be verified due to the currently growing number of studies on this topic. The objective of this systematic review is to update the evaluation of the effectiveness of school-based interventions published since the previous review according to the PRISMA guidelines. Studies published between August 2015 and August 2023 containing objective measures of ST were analyzed. Of the 18 studies identified, 11 (61.1%) reported significant positive results. Multi-component studies were slightly more effective than their single-component equivalent (63.7% vs. 57.1%). The components that proved the most effective of the multi-component studies were the implementation of sit-to-stand desks (100%), and teachers' training (77.8%). The combination of these two components is the most promising method to limit ST in the school context. Future research should determine how sit-to-stand desks can be introduced into the class environment and how courses can be adapted to this material.

Difference in Outdoor Time and Physical Activity During Recess After Schoolyard Renewal for the Least-Active Children

BACKGROUND

It remains unclear if schoolyard interventions "just" provide more opportunities for those children who are already active. The authors wanted to investigate schoolyard use and physical activity (PA) among the least-active children during recess following schoolyard renewals.

METHODS

An intervention study design with preresults and postresults comparison was used. Accelerometer and global positioning system data were collected at 6 Danish schools from 553 children at baseline and 439 after renewals (grades 4-9). Based on mean minutes of recess moderate to vigorous PA per child per school, the least-active children were defined as all children in the lowest activity quartile at baseline and follow-up, respectively.

RESULTS

One hundred and thirty-five children (70% girls) at baseline and 108 (76% girls) at follow-up were categorized as the least-active children. At follow-up they accumulated more time (12.1 min/d) and PA (4.4 min/d) in the schoolyard during recess compared with baseline. The difference in schoolyard PA found for the least-active children was relatively small compared with the difference for all children.

CONCLUSIONS

Solely improving the physical schoolyard environment seemed to have limited impact on the least-active children's PA. Future studies should investigate the complex interrelations between the least-active children and the entire schoolyard environment.

Effects of the KEIGAAF intervention on the BMI z-score and energy balance-related behaviors of primary school-aged children

The aim of the current study was to evaluate the one- and two-year effectiveness of the KEIGAAF intervention, a school-based mutual adaptation intervention, on the BMI z-score (primary outcome), and energy balance-related behaviors (secondary outcomes) of children aged 7-10 years.A quasi-experimental study was conducted including eight intervention schools and three control schools located in low socioeconomic neighborhoods in the Netherlands. Baseline measurements were conducted in March and April 2017 and repeated after one and 2 years. Data were collected on children's BMI z-score, sedentary behavior (SB), physical activity (PA) behavior, and nutrition behavior through the use of anthropometric measurements, accelerometers, and questionnaires, respectively. All data were supplemented with demographics, and weather conditions data was added to the PA data. Based on the comprehensiveness of implemented physical activities, intervention schools were divided into schools having a comprehensive PA approach and schools having a less comprehensive approach. Intervention effects on continuous outcomes were analyzed using multiple linear mixed models and on binary outcome measures using generalized estimating equations. Intervention and control schools were compared, as well as comprehensive PA schools, less comprehensive PA schools, and control schools. Effect sizes (Cohen's d) were calculated.In total, 523 children participated. Children were on average 8.5 years old and 54% were girls. After 2 years, intervention children's BMI z-score decreased (B = -0.05, 95% CI -0.11;0.01) significantly compared to the control group (B = 0.20, 95% CI 0.09;0.31). Additionally, the intervention prevented an age-related decline in moderate-to-vigorous PA (MVPA) (%MVPA: B = 0.95, 95% CI 0.13;1.76). Negative intervention effects were seen on sugar-sweetened beverages and water consumption at school, due to larger favorable changes in the control group compared to the intervention group. After 2 years, the comprehensive PA schools showed more favorable effects on BMI z-score, SB, and MVPA compared to the other two conditions.This study shows that the KEIGAAF intervention is effective in improving children's MVPA during school days and BMI z-score, especially in vulnerable children. Additionally, we advocate the implementation of a comprehensive approach to promote a healthy weight status, to stimulate children's PA levels, and to prevent children from spending excessive time on sedentary behaviors.Trial registrationNetherlands Trial Register, NTR6716 ( NL6528 ), Registered 27 June 2017 - retrospectively registered.

Sedentariness and Physical Activity during School Recess Are Associated with VO2Peak

Recess time (RT) is a main component of school-based activities, and could contribute up to 40% of the physical activity (PA) recommended in the health guidelines. The main goal was to analyze the association between accelerometer-measured PA and sedentary time during RT with cardiorespiratory fitness (CRF). A total of 146 children and adolescents, aged 8-19 years, were recruited from six schools. PA levels were measured with GT3X accelerometers over 7 days. CRF was measured using a portable breath-by-breath gas analyzer. A general linear model (GML) was conducted to analyze the association between PA intensities and CRF during RT. Additionally, a logistic binary regression was used to evaluate the risk of unhealthy CRF among different categories of PA and sedentary time. Participants classified as healthy showed higher PA levels during RT than those classed as unhealthy. GML analysis showed that sedentary time during RT was significantly associated with VO2Peak. Finally, individuals who were sedentary for more than 15 min during RT presented 97.7% lower odds of having unhealthy CRF (adjusted Odds Ratio = 0.023, 95% CI -0.002 to 0.263). Our data suggest an association between recess sedentary time and unhealthy CRF. Thus, school-aged children and adolescents must be empowered to perform PA during RT to prevent the deleterious effects of sedentary time on CRF.

Effects of an Autonomy-Supportive Physical Activity Program for Compensatory Care Students During Recess Time

The purpose of this study was to examine the effects of a physical activity-based intervention conducted during recess time for Spanish students with special needs. The intervention was designed to utilize an autonomy-supportive motivational style to promote feelings of autonomy and to contribute to increased physical activity involvement in these students. Participants were 62 students in the fifth and sixth year of elementary school, with ages between 10 and 12 years (M = 10.75 years, SD = 0.80 years). Students' perceptions of autonomy support, satisfaction of basic psychological needs, sport and physical activity motivation and actual physical activity level were assessed. A quasi-experimental design was employed with two intervention groups (autonomy-supportive and controlling styles), as well as a control group. Results indicated that students in the autonomy-supportive condition demonstrated a significant increase in feelings of autonomy and increased their physical activity levels while demonstrating a significant decrease in extrinsic motivation over the course of the intervention. The results provide support for the expectation that well-designed and theoretically based physical activity interventions can optimize learning and motivational outcomes for students in inclusive physical education settings.

The effects of student, school and neighborhood poverty on the association between fitness and absenteeism in New York City middle school youth

Recent research demonstrates that youth fitness improvements are associated with lower absenteeism. This study assessed whether the effects of poverty on the longitudinal fitness-absenteeism relationship are consistent across poverty measures at the student, school, and neighborhood levels and across sex in New York City (NYC) public school youth individually followed over 4 years. Negative binomial longitudinal mixed models with random-intercepts were developed stratified by five dichotomized student, school and neighborhood poverty measures and sex to test the change in fitness-lagged absenteeism relationship in six cohorts of NYC middle school students (2006/7-2012/13). Models were adjusted for individual-level race/ethnicity, place of birth, change in obesity status, grade, time, and school size. The sample included 360,743 students (51% male, 39% Hispanic, 28% non-Hispanic black, 69% qualifying for free/reduced price school meals). Adjusted estimates showed an inverse dose-response fitness-absenteeism relationship in high poverty youth across all poverty measures, including the student, school and neighborhood levels. For example, in girls exposed to high poverty based on school neighborhood, absenteeism decreased by 11.3% (IRR = -0.12, 95% CI: -0.20, -0.04), 10.4% (IRR = -0.11, 95% CI: -0.21, -0.02), 6.8% (IRR = -0.07, 95% CI: -0.14, 0.00) and 4.9% (IRR = -0.05, 95% CI: -0.15, 0.04) for students who had a >20% increase, 10-20% increase, <10% change, and 10-20% decrease in fitness from the prior year, respectively, relative to the reference group (>20% decrease in fitness). Future research should explore the impact of tailored interventions for youth that aim to promote youth physical activity at each of the individual, school and neighborhood levels, and particularly among high poverty subgroups.

Longitudinal Follow-Up of Physical Activity During School Recess: Impact of Playground Markings

To promote physical activity (PA) among children, few studies have reported long-term effects of playground marking during school recess. The aim of this study was to investigate the impact of a playground design on children's recess PA across 12 months and to evaluate the influence of covariates on the intervention effects with accelerometry data. Two hundred and eighty-three children (aged 6-11 years) were selected from 3 elementary schools. Two experimental schools received a recess-based intervention; the third one served as a control group. The design of playgrounds was based on a multicolored zonal design. Children's PA was measured with a uniaxial accelerometer twice a day (morning and afternoon recess) during a 4-day school week. Times spent below and above different PA levels, varying from sedentary (SED, <1.5 METs), light PA (LPA, <4 METs), and from moderate to very high (MVPA, ≥ 4 METs) were calculated before and after 6 and 12 months intervention. A three level (time, pupil, school) multilevel analysis was used to control the intervention effect across time on SED, LPA, and MVPA. The playground intervention was effective after 6 months for LPA (+2.5%, CI 0.65/4.29, P < 0.01) and after 12 months for MVPA (+3.1%, CI 0.62/5.54, P < 0.01). Moreover, negative non-significant intervention effects were found for SED and LPA. Baseline PA and sex were significant covariates to the contrary of body mass index and age. Playground markings intervention can modify positively long-term school recess total PA.

Increase in Physical Activity Sustained 1 Year After Playground Intervention

INTRODUCTION

Regular physical activity is a vital component of child health, and schools play an important role in the promotion of physical activity among children. This paper describes the implementation and evaluation of a playground redesign involving structural and loose play equipment to increase students' physical activity at an intermediate school in Leadville, Colorado.

METHODS

Direct observations were conducted during recess before the redesign in May 2014, then again at 6 months and 1 year after the redesign. During each observation, observers scanned the playground and counted how many students were sedentary, engaged in moderate activity, or engaged in vigorous activity. System for Observing Play and Leisure Activity in Youth, a validated instrument for observing physical activity in free play settings, was used to collect observation data.

RESULTS

Six months from baseline, the percentage of children engaging in moderate to vigorous physical activity during recess increased by 23.3%, and the percentage engaged in vigorous physical activity increased by 26.2%. These increases were sustained at 1 year from baseline, with an increase of 17.2% for moderate to vigorous physical activity and 33.1% for vigorous physical activity. Chi-square tests of independence showed that changes in the proportion of students engaging in moderate to vigorous physical activity and vigorous physical activity were statistically significant (p<0.01).

CONCLUSIONS

This evaluation demonstrated that environmental interventions involving the provision of structural and loose play equipment can be implemented in an intermediate school setting, and can create a sustainable increase in physical activity among students during recess. This example also demonstrates that schools and community organizations can evaluate the impact of these interventions using relatively simple, low-cost observational methods.

SUPPLEMENT INFORMATION

This article is part of a supplement entitled Building Thriving Communities Through Comprehensive Community Health Initiatives, which is sponsored by Kaiser Permanente, Community Health.